Nodal stage after induction therapy for stage IIIA lung cancer determines patient survival

Background. This study was undertaken to determine the predictive value of nodal status at resection in regards to long-term outcome of patients under going neoadjuvant therapy and resection for stage IIIA N2-positive non-smal l cell lung cancer (NSCLC). Methods. We reviewed the medical records of all patients found on surgical staging to have N2-positive NSCLC and who underwent induction therapy follo wed by resection between 1988 and 1996 at our hospital. Complete follow-up information was examined utilizing Kaplan-Meier survival analysis and Cox p roportional hazards multivariate analysis. Results. One hundred three patients (59 men) with stage IIIA N2-positive NS CLC received neoadjuvant therapy before surgical resection. Preoperative th erapy consisted of platinum-based chemotherapy (76), radiotherapy (18), or chemoradiation (9). Operations included pneumonectomy (38), bilobectomy (6) , and lobectomy (59). There were four deaths and seven major complications. Eighty-five patients were followed until death. Median survival among 18 living patients is 60.9 months (range 29 to 121 mo nths). Twenty-nine patients were downstaged to NO and had 5-year survival o f 35.8% (median survival 21.3 months). Seventy-four patients with persisten t tumor in their lymph nodes (25 N1 and 49 N2) had significantly worse, 9%, 5-year survival, p = 0.023 (median survival 15.9 months). Other negative p rognostic factors were adenocarcinoma and pneumonectomy. Conclusions. Patients with N2-positive NSCLC whose nodal disease is eradica ted after neoadjuvant therapy and surgery enjoy significantly improved canc er-free survival. These data support surgical resection for patients downst aged by induction therapy; however, patients who are not downstaged do not benefit from surgical resection. Direct effort should be made to improve th e accuracy of restaging before resection. (Ann Thorac Surg 2000;70:1826-31) (C) 2000 by The Society of Thoracic Surgeons.